GOVT.

MODEL AYURVED COLLEGE

KOLVADA
GANDHINAGAR

GUJARAT AYURVED UNIVERSITY

JAMNAGAR

DEPARTMENT OF SWASTHAVRITTA

COMPILATION WORK

NAME OF STUDENT:- PATEL MANANKUMAR KANAIYALAL

ROLL NO.:- 28
EXAMINATION NO.:-
 STATE MODEL INSTITUTE OF AYURVEDA SCIENCE
KOLVADA
GANDHINAGAR

CERTIFICATE
This is to certify that Mr./Mrs. MANANKUMAR . K.PATEL
Third Professional Ayurvedacharya (B.A.M.S.) student of
affiliated to Gujarat Ayurved University for the academic year 2019-2020
Roll no and Examination No ,has satisfactorily prepared compilation of
Swasthavritta under the supervision of Swasthavritta
department.
Gandhinagar
Date:-
SIGN OF LECTURER SIGN OF HEAD OF DEPARTMENT

SIGN OF EXAMINER 1:- SIGN OF EXAMINER 2:-

SR.NO. TOPIC PAGE NO.
1. ABSTRACT 04
2. INTRODUCTION 05
3. EPIDEMIOLOGY 06
4. TRANSMISSION 07
5. CAUSE 08
6. SYMPTOMS 09
7. CONTROL 10
8. VACCINES 12
9. NEED FOR FUTURE 13
10. CONCLUSION 14
11. BIBILOGRAPHY 15
Abstract
 Diarrhoeal diseases are still responsible for about 3 million deaths each year in
the world.
 TF is reported in school age children 5-19 years age.
 This emphasizes the desirability of having additional systemic epidemiological
studies from severaL other Geographic regions to document if this
phenomenon is common to virtually all TF endemic areas or if it is related to the
difference in epidemiological methods.
 The wide spread emergence of strains resistance to multiple antibiotic
throughout the middleEast, South and Southeast Asia, Northeast Africa and most
recently CentraL Asia, stimulated efforts to develop effective treatment and
vaccines against this disease.
 Two effective vaccines are currently available and licensed: one injectable ,
polysaccharide, given in one dose and one oral, Iive Ty21a, given in three
doses two days apart.
 The target population for the use of these vaccines would be school age children
or infants at EPI immunization time. Other important target population include
travelers and clinical microbiology technicians.
 In conclusion, there is a need for
(i) quantifying in a more precise manner the global burden of TF,
(ii) quantifying the incidence of bacteremic disease in infants and toddlers
(iii) developing simple and effective diagnosis tools.
INTRODUCTION:
 In the early nineteenth century large-scale human migrations led to rapid
increases in the population of cities in Europe and North America, living
under crowded conditions in the absence of treated water supplies or
sanitation.
 TF came to be highly endemic in most of these countries. In these regions, in the
late nineteenth and early twentieth century water treatment and appropriate
sewage disposals led to an impressive decline in the incidence of TF in
industrialized countries.
 TF is very difficult due to financial country which makes it almost impossible to
provide adequate water treatment and sewage disposal.
 In such countries TF remains an important public health problem causing high
morbidity and mortality with high impact on socioeconomic aspect.
 Prevention of enteric diseases comprises basic sanitary and hygiene measures,
including purifying water supplies, improving water delivery and sewage
control.
 Most of the times however, it is difficult to properly apply these
recommendations. It appears therefore, that there is a need for an effective
public health tool to control TR and the potential use of effective vaccines in
appropriate condition should be considered.
EPIDEMIOLOGY:
 It is difficult to estimate the real impact of the disease in the world because the
clinical picture is, most of the time, confused with many other febrile infections.
 However it has been estimated that more than 16 million of TF cases
occur annually in the world, causing more than 600,000 deaths.
 These data are based on the literature and the incidence of TF in the
control groups during field trials of candidate vaccines evaluated in
endemic areas.
 However it is now widely believed by public health authorities that these
estimates of the global burden of TF may have been five to ten times too low.
 Ideally we think that it would be of high interest to have systematic blood culture
surveillance for TF in multiple areas of several countries including those where TF
is not perceived to be a major health problem, as it is in the sites selected for
vaccine trials.
 Data obtained from such systematic surveillance would allow a more realistic
estimate to be calculated of the global burden of TF.
 In Indonesia, Tajikistan , Chile, and Peru a high incidence of TF is seen in
children from 5 to 19 years of age, whereas infants show much lower incidence
rates.
 This observation raises the question of whether infants and toddlers are relatively
spared from TF because they fail to ingest the vehicles of transmission that infect
older persons or whether they in fact become infected at high incidence but
certain host factors modify the clinical response such that typical TF does not
ensue.
 Another explanation could also be the underestimation of TF cases. A study was
conducted in Chiles in infants and toddlers brought to health centers who had
been checked for blood culture (Salmonella typhi and Salmonella paratyphi B) for
those who presented high temperature.
 In some of them(3.5%), blood cultures were positive and their symptoms were
clinically classified as "Viral Infection”.
 It is important to notice that some countries, like Bangladesh, India Jordan and
lran, reported high incidence in children less than 5 years of age.
 However it must be emphasized that some of these studies also include
patients with enteric fever caused by S. paratyphi.
TRANSMISSION:
 Typhoid fever and paratyphoid fever are transmitted commonly through the
consumption of drinking water or food contaminated with the feces of
people who have typhoid fever or paratyphoid fever or of people who are
chronic carriers of the responsible bacteria.
CAUSES OF TYPHOID:
 Typhoid is caused by salmonella typhi, a bacterium from the same genus that
causes salmonella food poisoning.
 Typhoid is spread through contact with infected of people faeces and urine.
 This makes it very common in countries with poor sanitation, where human
waste can find its way into sources of drinking water and the food chain.
SYMPTOMS:
 Symptoms of typhoid fever are here

1. Weakness
2. Stomach pain
3. Headache
4. Diarrhea or constipation
5. Cough
6. Loss of appetite
7. High grade fever with chills
CONTROL MEASURES:
 The current control measures include health education and antibiotics treatment
Basic measures of sanitation and hygiene includes purifying water supplies,
improving water delivery and sewage control, supplying hand-washing facilities,
latrines, boiling water and supervising food-handlers.
 However, for different reasons, it is difficult to properly apply these measures
which showed to be unable to eliminate completely the problem of enteric
diseases including TF.
 Complementary efforts to develop effective tools for public heath control of the
disease are needed and essential today.
 Since 1948, treatment of patients was usually conducted through
oral chloramphenicol which was highly effective in treating acute TF.
 During the 1960s when chloramphenicol therapy for TF was wides pread,Shigella
rapidly acquired resistance factor plasmids encodingresistance to
chloramphenicol.
 Chloramphenicol , ampicillin, and co-trimoxazole were widely used and
constituted the so called "first-line antibiotics against S. typhi".
 However, since 1960 progressive resistance 1 or 2 of these first line antibiotics
has been reported.
 Circa 1990, sporadic cases and localized outbreaks began to appear caused
by strains of S. typhi encoding mediated resistance to trimethoprim
/sulfamethoxazole , as well as to chloramphenicole.
 Therapy of such strains requires the use of quinolone antibiotics such as oral
ciprofloxacin or third generation cephalosporins such as parenteral ceftriaxone,
antibiotics that are costly for developing countries.
 However, the need for increasing doses of ciprofloxaciri has been reported from
India and resistance to nalidixic acid and ciprofloxacin itself has yet been
described in patients returning to the UK from India.
 In contrast with previous antibiotic-resistant strains that caused sporadic cases or
extended epidemics, as in Mexico from 1972-1973 and Peru from I979-I98I, and
that eventually disappeared to be replaced once again by sensitive strains, the
multiply-resistant S.typhi.
 Typhi strains that appeared in the Middle East and the Indian sub-continent circa
1990are still the dominant strains in those areas. Moreover,these multiply-
resistant strains have spread widely and are prevalent in northeast africa and
southeast Asia.
 It appears that ,S. typhi manifesting resistance to multiple previously useful
antibiotics may be here to stay.
 Thus, once again, typhoid fever is no longer a simple, inexpensive disease to treat
with oral anti-biotices that health authorities can base control programs in large
part on early treatment of disease.
 Complications of typhoid fever and deaths are on the increase because of
inappropriate, delayed or inadequate antibiotic therapy.
 VACCINES
 This topic will be discussed by other sources ,we will not go into details, but just
mention the current available vaccines, licensed and already widely used by
travelers.
 Widal test is necessary for typhoid fever.
 Two vaccines are currently available, one in-jectable ( polysaccharide
vaccine)given in one dose and another oral given in three doses two days apart.
 Both are effective and very well tolerated. A large field trial evaluation was done
in 200,000 children showing that vaccination in school-aged children would be
practical and realistic; unfortunately there is a lack of programmatic use of these
vaccines for controlling TF.
 Microbiologist, travelers, people in refugee camps ,and children could
represent the target population for vaccination. Should the incidence of TF be
confirmed during the school years in children between 5 to 19years of age, the
best time to immunize would be school time.
 Potential vaccines to be used would be either Vi or Ty2Ia.
 the incidence be reported in children less than 5 years of age, the EPI
time should be more appropriated using a Vi-conjugate vaccine.
 Recommendation for using vaccines against TF for routine prevention
programmes have previously been presented.
NEEDS FOR THE FUTURE

 Two epidemiologic questions beg to be answered in a definitive manner to

provide information that will help direct international efforts to control TF.
 The first relates to updating the real burden of TF in most Of the developing
countries.
 The second concerns the precise evaluation of the incidence of the disease in
infancy, in conducting bacteremic determination in infants and toddlers less than
2 years of age.
 The target age from 5 to 19 years be confirmed, it would be of high interest that
one or several countries undertake demonstration projects based on school
immunization with the currently available vaccines.
 For countries where the target age is in children less than 5 years of age, TF
vaccines should be administered during EPI schedule, with DTP vaccine for a
number of dose vaccine or at measles time for a one dose vaccine.
 In any case, there is a need for data to show that if these vaccines are given to
infants they would elicit enduring protective immunity that would protect years
later when the children reach the school age years.
 Another need concerns the potential use of TF vac-cines in an outbreak situation.
No data exist to know whether or not the use of TF vaccines could be an effective
tool for controlling the epidemic.
 Usually the strains responsible for epidemic are multi drugs resistant and raised
the question of the interest of preventive measures like vaccination to control the
disease.
 Cost effectiveness studies could be conducted to have information helping
decision makers in their recommendation.
CONCLUSION
 Morbidity and mortality from typhoid fever remain an important problem for
public health authorities in developing countries.
 Control of the disease was conducted with effective antibiotics, unfortunately the
emergence and the world-wide spread of S. typhi strains that are resistant to
most previously useful antibiotics raises again the question of an effective tool for
controlling this disease.
 As a consequence, there is renewed interest to better understand the
epidemiology of typhoid fever and some aspects of its pathogenesis.
 More importantly, perhaps, there is much pre-occupation in exploring expanded
roles for typhoid vaccines.
 One important challenge for public health authorities is to devise ways to utilise
the two currently available improved typhoid vaccines, oral Ty2la and
parenteral Vi polysaccharide, in large-scale school-based immunisation
programs and monitor the public health impact.
 Since humans constitute the reservoir of typhoid infection through shoft-term
and long-term carriers, vaccines that actually prevent infection with wild type ^S.
typhi as well as conferring protection against clinical illness can, if used in con-
junction with other control measures, help eradicates. typhi disease even in less-
developed regions of the world.
BIBILOGRAPHY

 PARK’S TEXTBOOK OF COMMUNITY AND SOCIALMEDECINE-K.PARK.

 TEXTBOOK OF PREVENTIVE AND SOCIAL MEDECINE BY MAHAJAN GUPTA
 https://www.who.int/news-room/q-a-detail/typhoid-fever
 https://www.mayoclinic.org/diseases-conditions/typhoid-fever/symptoms-
causes/syc-20378661
 https://www.cdc.gov/typhoid-fever/index.html